Relation of cerebral vessel disease to Alzheimer's disease dementia and cognitive function in elderly people: a cross-sectional study.
Relation of cerebral vessel disease to Alzheimer's disease dementia and cognitive function in elderly people: a cross-sectional study.
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DOI：
10.1016/s1474-4422(16)30029-1
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发表时间：
2016-08
期刊：
影响因子：
--
通讯作者：
Schneider JA
中科院分区：
文献类型：
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作者：
Arvanitakis Z;Capuano AW;Leurgans SE;Bennett DA;Schneider JA
很少有关于脑血管疾病、痴呆症和认知的病理数据。这项横断面研究在一大群接受尸检的老年人中，检测了大脑动脉粥样硬化和动脉硬化神经病理与可能的阿尔茨海默病(AD)痴呆和认知功能水平的关系。1143名老年女性或男性(死亡年龄中位数=88.8岁；42%患有阿尔茨海默病)接受了年度临床评估，并同意在死亡时进行脑部尸检，这是两项关于老龄化的队列研究之一。使用濒临死亡的神经心理学数据来创建全球认知和认知域的汇总测量。所有年份的数据被用来确定阿尔茨海默病临床综合征的存在。系统的神经病理学评估记录了脑部大血管疾病(动脉硬化)和小血管疾病(动脉硬化)的严重程度。通过对人口统计学、粗微梗塞和AD病理进行调整后的回归分析，我们检查了血管疾病严重程度与可能和可能的AD痴呆的几率以及认知水平的关系。445名(39%)受试者出现中度至重度动脉粥样硬化，401名(35%)受试者出现小动脉硬化。中至重度动脉粥样硬化(OR=1.33；95%CI：1.11~1.58)和小动脉硬化(OR=1.20；95%CI：1.04~1.40)是AD痴呆的高危因素。动脉粥样硬化与整体认知(Estimate=−0.10，SE=0.04；p=0.00096)和四个认知领域(情景记忆、语义记忆、知觉速度和视觉空间能力；均为p<；0.019)得分较低有关，但与工作记忆无关(p=0.21)。动脉硬化与整体认知(Estimate=−0.10，SE=0.03；p=0.0015)和四个领域(均为p<；0.046)得分较低有关，与视觉空间能力呈边缘/非显著相关(p=0.052)。在控制载脂蛋白Eε4和血管危险因素的分析中，结果没有变化。大脑动脉硬化和动脉硬化每增加一级严重程度就会使阿尔茨海默病的患病几率增加20%-30%，并与大多数认知领域的较低分数有关。考虑到阿尔茨海默病和脑梗塞的病理以及血管因素后，相关性仍然存在。脑血管病变可能是AD痴呆的一个未被认识的危险因素。美国国立卫生研究院。
Few pathologic data are available on cerebral vessel disease, dementia, and cognition. This cross-sectional study examined associations of cerebral atherosclerosis and arteriolosclerosis neuropathology with probable and possible Alzheimer’s disease (AD) dementia and level of cognitive function, in a large group of older persons who came to autopsy. 1,143 older women or men (median age-at-death = 88.8 years; 42% with AD dementia) underwent annual clinical evaluations and agreed to brain autopsy at time-of-death, as part of one of two cohort studies of aging. Neuropsychological data proximate-to-death were used to create summary measures of global cognition and cognitive domains. Data across all years were used to determine presence of the clinical syndrome of AD dementia. Systematic neuropathologic evaluations documented severity of cerebral large (atherosclerosis) and small vessel disease (arteriolosclerosis). Using regression analyses adjusted for demographics, gross and micro-infarcts and AD pathology, we examined associations of vessel disease severity with odds of probable and possible AD dementia and level of cognition. Moderate-to-severe atherosclerosis was present in 445 (39%) subjects, and arteriolosclerosis in 401 (35%). The odds of AD dementia was higher with moderate-to-severe atherosclerosis (OR=1.33; 95%CI:1.11–1.58) and arteriolosclerosis (OR=1.20; 95%CI:1.04–1.40). Atherosclerosis was associated with lower scores for global cognition (estimate= −0.10, SE=0.04; p=0.00096) and four cognitive domains (episodic memory, semantic memory, perceptual speed and visuospatial abilities; all p<0.019) but not working memory (p=0.21). Arteriolosclerosis was associated with lower scores for global cognition (estimate= −0.10, SE=0.03; p=0.0015) and four domains (all p<0.046), and a borderline/non-significant association was noted for visuospatial abilities (p=0.052). Findings were unchanged in analyses controlling for APOEε4 and vascular risk factors. Cerebral atherosclerosis and arteriolosclerosis each contribute to the odds of AD dementia by 20–30% per level increase in severity, and are associated with lower scores in most cognitive domains. Associations remain after taking into account AD and infarct pathologies, and vascular factors. Cerebral vessel pathology may be an under-recognized risk factor for AD dementia. United States National Institutes of Health.